微创多平面支撑螺钉在Pilon骨折手术中的应用

Application and Exploration of Minimally Invasive Multiple Planar Support Screws in Pilon Fracture Surgery

目的探讨微创置入多平面螺钉支撑结合主力钢板治疗严重粉碎Pilon骨折的疗效及可行性。方法回顾性分析接受单一主力钢板结合螺钉多平面支撑固定微创手术治疗的22例Pilon骨折患者的临床资料,术后采用Burwell-Charnley放射学评价标准评价关节面复位情况,末次随访采用Tornetta评价标准评价踝关节功能。结果22例患者均获随访,随访时间13~25个月,平均19.3个月。术后根据Burwell-Charnley标准评价关节面复位情况,解剖复位20例,复位可1例,复位差1例,22例患者均获骨性愈合,愈合时间3~6个月,平均3.8个月;术后12~25个月取出内固定,平均17.3个月。根据Tornetta标准评价踝关节功能恢复情况:优13例,良8例,可1例,优良率为95.5%。所有患者均未出现踝部创口边缘张力性水疱、皮肤坏死、感染等并发症,其中1例出现内置物排异反应,3个月后取出内植物获得良好愈合;1例出现创伤性关节炎,患者要求保守治疗。结论微创多平面螺钉支撑结合主力钢板治疗严重粉碎Pilon骨折,关节面可以获得较好的解剖复位,还可有效减少甚至避免切口并发症,远期临床效果满意。

Objective To explore the clinical effect and feasibility of minimally invasive placement of multiple planar screws support combined with main plate in the treatment of sever comminuted Pilon fractures.Methods A retrospective analysis was conducted on 22 patients with Pilon fractures who underwent minimally invasive surgical treatment using a single main plate combined with screw multiplanar support fixation.Burwell-Charnley radiological evaluation criteria were used to evaluate the reduction of the joint surface after surgery,and Tornetta evaluation criteria were used to evaluate ankle joint function in the final follow-up.Results All 22 patients were followed up for a period of 13~25 months,with an average of 19.3 months.After surgery,the reduction of the joint surface was evaluated according to Burwell-Charnley standard.Among 20 cases,anatomical reduction was achieved in 20 cases,1 case of fair reduction and 1 case of poor reduction.All 22 patients achieved bone healing,with a healing time of 3~6 months,with an average of 3.8 months;internal fixation was removed 12~25 months after surgery,with an average of 17.3 months.According to Tornetta criteria,the recovery of ankle joint function was evaluated as excellent in 13 cases,good in 8 cases,and fair in 1 case,with an excellent and good rate of 95.5%.All patients had no complications such as wound edge blistering,skin necrosis and infection.Among them,1 case of internal fixation rejection occurred,and the incision was well healed after removal of the internal fixation after 3 months.1 case developed traumatic arthritis and requested conservative treatment.Conclusion Minimally invasive treatment of sever comminuted Pilon fracture with main plate combined with multiple planar screws for supporting fixation not only prvides a better anatomical reduction of joint surface,but also effectively reduces or even avoids incision complications.The long-term clinical results are satisfactory.